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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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High resolution manometry metrics and thresholds

High resolution manometry metrics and thresholds
Assessment Pressure topography metrics Definition Diagnostic threshold Additional considerations
Relaxation pressure across the esophagogastric junction in response to deglutition Integrated relaxation pressure (IRP) Mean of the 4 s of maximal deglutitive relaxation in the 4-s window beginning at UES relaxation, contiguous or non-contiguous, referenced to gastric pressure Abnormal deglutitive IRP relaxation:
  • Supine median IRP ≥15 mmHg (Medtronic)
  • Supine median IRP ≥22 mmHg (Laborie/Diversatek)
  • Upright median IRP ≥12 mmHg (Medtronic)
  • Upright median IRP ≥15 mmHg (Laborie/Diversatek)
 IRP >12 mmHg (Medtronic) on rapid drink challenge (RDC) or IRP >25 mmHg (Medtronic) on solid test meal supports outflow obstruction
Esophageal peristalsis Distal contractile integral (DCI) – contractile vigor Amplitude × duration × length (mmHg•s•cm) of the distal esophageal contraction exceeding 20 mmHg from the transition zone to the proximal margin of the LES
  • Normal contraction: DCI 450 to 8000 mmHg•s•cm
  • Weak contraction: DCI >100 and <450 mmHg•s•cm
  • Failed peristalsis: DCI <100 mmHg•s•cm
  • Hypercontractile swallow: DCI >8000 mmHg•s•cm
  • Ineffective swallow: weak contraction or failed peristalsis
 Intact contractile response on multiple rapid swallow (MRS): DCI <100 mmHg•s•cm during MRS and DCI greater than single swallow mean DCI following MRS
Contractile wavefront integrity Contiguity of peristalsis in an isobaric contour of 20 mmHg
  • Ineffective swallow: peristaltic break >5 cm in setting of a DCI ≥450 mmHg•s•cm
  
Latency of deglutitive inhibition Distal latency (DL) Interval between UES relaxation and CDP
  • Premature/spastic contraction: DL <4.5 seconds in setting of a DCI ≥450 mmHg•s•cm
  
Pressurization Isobaric contour  
  • Panesophageal pressurization: isobaric contour of ≥30 mmHg
  • Intrabolus pressurization: isobaric contour of ≥20 mmHg in the supine position (Medtronic)
 Panesophageal pressurization >20 mmHg on RDC or solid test meal supports outflow obstruction
UES: upper esophageal sphincter; LES: lower esophageal sphincter; CDP: contractile deceleration point.
From: Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0 ©. Neurogastroenterol Motil 2021; 33(1):e14058. https://onlinelibrary.wiley.com/doi/10.1111/nmo.14058. Copyright © 2020 John Wiley & Sons Ltd. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department on [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (http://onlinelibrary.wiley.com).
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